Dental Implants in Edinburgh

We are often asked if any of the team is a ‘specialist’ in dental implants – the answer to that question is no because, as yet, there is no specialism in the field. As there is no specialism in the field of dental implants – a dentist can’t be called a specialist in dental implants.

Our implant surgeon, Philip Friel, has completed years of focused implant training and ongoing personal development in the area to ensure he can offer the best possible standard of patient treatment and care. All of our dentists at New Town Dental Care are experienced in the restoration of dental implants. Looking to find out more about dental implants in Edinburgh? Below is some very useful information about dental implants and the work we can do.

Step by step for routine dental implants

Diagnosis and treatment planning appointments together with the completion of any reparative or preparatory work on remaining teeth or bone.

Implant placement is usually followed by a healing period of anything from six weeks to six months. Often the implants are completely hidden beneath the gum; however, one-stage procedures where the implant is visible from the time of placement are also common. Stitches are normally removed within seven to 10 days and many will dissolve on their own.

Several visits may be needed over the first few weeks to adjust temporary teeth or dentures and to monitor healing.

The time allowed for implants to integrate may be increased or decreased to suit the bone conditions.

In some cases, the first teeth fitted in the implants are not the final ones, but replicas of the proposed design. This stage can be used to assess the restorations, particularly in areas like the front of the mouth where appearance is more critical. This also gives the gums time to mature around each implant before the final teeth are fitted.

Final teeth are commonly fitted between three and nine months after placement of the implants.

In conjunction with the patients maintenance of an excellent oral hygiene, regular examination and hygiene appointments are then all that is required to maintain the health of the mouth, teeth and implants.

Dental Implant Information

Implants have transformed dentistry over the last 35 years and are now often the first choice of treatment for the replacement of missing teeth.

An implant is a titanium substitute for a natural tooth root and is placed into a socket created in the jaw. It is usually screwed into place creating an initial stability, which over time is steadily enhanced by further growth of bone on to the implant surface. This process of fusion of bone to implant is known as osseo-integration. The internal design of the implant allows a variety of fitments to be attached to it, which support replacement teeth, providing the foundation for long-term support of crowns, bridges or dentures.

Almost all implants today are made from titanium, which has proven to be well tolerated by bone.

How many teeth can be supported?

All the common forms of tooth replacement, such as bridges or dentures can be supported by implants. If you are missing just one natural tooth, the one implant will likely be all that is required – but larger spaces of two, three or more missing teeth will not necessarily need one implant per tooth.

Successful implants depend on the quality and volume of bone at the point where the implant is required.

In the upper jaw for example, bone density is generally poorer than in the lower and if you have no teeth at all, most treatment providers will want to place a minimum of six implants to support a complete arch of 12 replacement teeth.

Because the bone at the front of the mouth is often very strong, fewer implants may be needed than would be required to treat a whole upper jaw – therefore a simple treatment plan to provide 10 or more teeth in the lower jaw might be possible with as few as four implants.

What else can be done with dental implants?

If you have no teeth in the lower jaw – a conventional lower denture can be considerably improved with an implant retained “over denture” which involves two implants placed at the front of the lower jaw to secure a denture. The same concept can be used in the upper jaw; however, four implants are used in the upper jaw and generally linked together to increase stability.

There are many implant options available and it is crucial that you have a thorough dental examination to be aware of what treatment would be best for you. For example implants have to obey simple engineering principles, in that sufficient implants must be placed in strong foundations to prevent overloading.

Each implant must be accessible for daily cleaning so that the biology of the mouth maintains healthy bone and gum surrounding the implant.

Am I suitable for dental implants?

If you have good general health and maintain good oral health, then implants will almost certainly work for you. Habits such as poor oral hygiene, heaving drinking or smoking can increase the number of problems associated with initial healing after surgery and maintenance. In some cases, if the risk factors are too great, your dentist may decline to place the implants until such times as these are brought under control.

It is rare to have health problems that will prevent the use of implants and at New Town Dental Care, we regularly liaise with general medical practitioners and other medical specialties to co-ordinate care for those patients who are on medications or have conditions, which need to be carefully controlled

Do I need to have a healthy mouth?

For optimum success, implants should be placed in the environment of a healthy, well maintained mouth. As part of any treatment plan, any initial remedial treatment and maintenance advice and planning will be included to achieve the ideal environment for implant placement.

Basic dental health which includes the treatment of gum disease, repair of decay and the elimination of infection will be important for the long-term success of implant treatment.

If you are aware of bad breath, loose teeth, or have noticed excessive bleeding – particularly when your teeth are professionally cleaned – you may have gum problems and gum disease is a major cause of bone loss and with reduced bone dental treatment or dental implant treatment can be more complicated.

What causes bone loss?

Whenever a tooth is lost, some of the bone, which supports it, will be lost over time. Depending upon the extent of this bone loss, bone grafting may be required in order to restore adequate bone volume for implant placement. In some cases, either grafting the tooth socket using a socket preservation technique to maintain the bone, or placing an implant immediately into the socket to support and maintain the supporting bone can prevent this bone loss.

How long does treatment take?

For routine cases, from the time of implant to the placing of the first tooth, treatment times can vary between a few weeks to six months. The better the bone the less will be the treatment time and with poorer bone more time and care must be taken which can extend treatment time beyond six months.

Be prepared to wait if there is no reason to shorten the duration of treatment – nobody looses an implant from being patient and allowing nature to take its course.

Whilst implant treatments are very successful, any problems with the implants integrating with the bone may result in the treatment time extending which patients must be prepared for.

Are the new teeth joined together?

When multiple implants are placed they are routinely joined together in the same way, as a bridge supported by natural teeth would be designed.

It is often easier and just as effective to make several smaller sections of bridgework each supporting a few teeth. The overall effect is the same and makes it easier if any repair work is needed on one of the small sections.

Again the bone quality and the number and position of the implants will determine which option is best suited to you and this would be discussed fully and planned at the treatment planning stage.

How do i take care of the implants?

Following all stages of implant treatment you will be fully advised on care and maintenance of the implants or the superstructure that they support. This instruction will include how to clean adequately and what techniques and materials to use to assist in achieving this. Whilst full instruction is given and demonstrated, it must be understood that the adequate care and maintenance of the implants requires regular effort on the patient’s part at home for ideal maintenance. Adequate care can be achieved using brushes, flosses and interdental brushes and waterpiks. At PFAD, we recommend the use of the Phiiips Sonicare toothbrush.

It is recommended that implants be cleaned every 3 months by the dental hygienist to ensure adequate review and maintenance.

Also it is reasonable to expect some of the daily hygiene procedures to be a little more complex than around original teeth, so expect to spend more time than you have done in the past to maintain optimum implant health.

For the first few months your dentist may ask to see you more frequently, but once the implants are performing as planned, ongoing care will be similar to that with ordinary teeth.

How long will the implants last?

Once your implants and surrounding soft tissues are seen to be healthy and your new teeth are comfortable and correctly adjusted, it is the quality of your home care, and willingness to present for regular maintenance reviews, that will most influence how long they will last. When poorly cared for, implants develop a covering of deposits similar to that found on neglected natural teeth. Left untreated, these can lead to gum infection, bleeding, soreness and general discomfort, just as can occur around natural teeth. It could probably be said that implants, much like natural teeth, will last for as long as you care for them. Well-maintained implants, placed into adequate bone, can be expected to last for many years. However, just as with other surgical implants (such as a hip replacement) there is no lifetime guarantee.

How will i know if i’m suitable for implants?

As well as a complete examination of your mouth and remaining teeth you will be expected to supply details of your medical history. X-rays will be updated and study models and photos taken as required. In addition, full discussion with regards to requirements and expectations will allow us to determine if implant treatment is appropriate.

Good basic dental health and maintenance of this is essential to maintain implants in the mouth.

What should i know before i start treatment?

You should be given a written summary of your treatment planning consultation, which should outline your current dental situation, the proposed treatment and any alternatives there are to dental implants. This summary should include an overview of the stages of treatment to give you some idea of how long the whole process will take, how many implants required and the likely cost. In addition, patients are given lots of information and afforded many opportunities to ask as many questions as they wish to ensure that they are comfortable with the proposed treatments.

Do i have enough bone for implants?

Both clinical examination and x rays are used in order to assess and determine the volume and position of bone remaining in an area after tooth loss.

Dental x-rays show large amounts of detail in two dimension, but sometimes more advanced imaging might be needed to determine bone volume in three dimensions and the position/proximity of important structures such as nerves and sinuses.

Dental CT Scans – Images obtained by CT scanning will normally be able to show all of the information required about your bone, including quantity and quality, but most importantly to ensure the presence of nerves and suchlike are avoided. AT PFAD, we are one of only a small number of clinics to own our own Cone Beam CT scanner that allows such images to be taken easily. More information on this scanner can be accessed in the treatments section.

Can dental implants be placed next to my natural teeth?

Implants are routinely placed beside natural teeth and this is a predictable procedure so long as there is adequate bone to allow the support of both the natural tooth and implant. Such areas are carefully assessed and measured as part of the planning process.

If a tooth is accidentally damaged by an implant, any resulting problems can generally be resolved by root canal treatment in which the nerve of the natural tooth is removed. Such incidents are extremely rare.

Can i wear teeth during the implant treatment and healing periods?

If the teeth being replaced by implants are in a clearly visible part of the mouth, it is most likely that you will want to have some teeth present during treatment. This can be achieved by the use of simple plastic dentures or temporary bridges. In some instances, temporary teeth or bridges will be attached immediately to the implants after placement.

If replacement teeth are used during treatment it is important that they do not put undue pressure on the underlying implants and patients may be advised not to wear temporary teeth for a few days after surgery to allow the initial healing to progress unimpeded. Full advice in this regard will be given as part of the treatment planning stages.

Is it uncomfortable when the implants are placed?

Implants are placed using the same familiar dental local anaesthetics used for routine dentistry. Depending on the complexity of the case, the operation might take anything from 20 minutes for a simple single implant to 90 minutes for complex bone grafting and multiple implant procedures.

Swelling, tenderness and occasionally bruising can be expected after the surgery and full postoperative instructions are given to patients together with any relevant medications such as antibiotics. The exact extent and nature of any swelling, tenderness and bruising varies between individuals and procedures but should resolve within 5-10 days after the surgery. At PFAD, all patients have mobile telephone contact details for dentists at all times should they have any concerns or queries.

Can sedation or anaesthetic be given for longer surgery?

Most people will be anxious over all but the simplest implants. It should be borne in mind, that although by their nature, the procedures are invasive; they are carried out gently and with great care to ensure the tissues, which are prepared, are respected to allow them to successfully receive the proposed implant or graft material. In general, implants are carried out under local anaesthesia, however, there are several adjunctive methods, which can make the procedure more relaxing.

Oral sedation – Medication such as Temezepam may also be used to help relax anxious patients for uncomplicated surgery taking less than an hour.

Conscious sedation – For treatments of greater complexity conscious sedation has the advantage of keeping patients relaxed but alert enough to respond to simple instructions from the surgeon – yet they will remember almost nothing of the treatment.

A carefully controlled amount of sedative is delivered through a vein for as long as the treatment takes and heart rate and oxygen levels are monitored throughout. This is a very safe and effective method of gaining relaxation during the procedure.

General anaesthesia – General requires a hospital admission and is mainly used for very complex cases such as bone grafting from the hip to the mouth or where large numbers of implants are being placed at the same time. It should be borne in mind that general anaesthesia carries risks that may outweigh its use for an elective procedure such as dental implants.

If i do not have enough bone what can be done?

For some people bone loss after tooth infection or the removal of teeth leaves them without enough to secure an implant and in such cases simple bone grafting/onlay grafting or sinus augmentation may be required.

Simple bone grafting – Simple bone grafting involves the use of a bone substitute and a barrier membrane, which are used to reform the desired contours of a particular area following bone loss. Over time, the body will replace this bone with its own bone in a process known as Guided Bone Regeneration. This type of grafting is carried out commonly with Bovine (cow) bone graft together with a porcine (pig) barrier membrane.

Sinus augmentation – Following the loss of the upper posterior teeth, the resulting force differences can allow the air sinus in the area to increase in size. This in turn means that the bone height available for implant placement in this area may be diminished. In order to replace the volume of bone in these areas to allow the successful placement of implants, sinus elevation and grafting procedures can be carried out. This is a more involved procedure but one which is carried our regularly in the clinic. During this procedure the sinus is accessed and the lining gently elevated allowing bone graft material to be placed forming increased foundation for the placement of implants. A skilled surgeon can achieve good, predictable results by this method, without which many patients would be unable to have implants.

Onlay grafting – Where severe bone loss has occurred requiring either a large increase in volume, or a potential increase in vertical bone height, bone volume can be increased by taking a piece of bone from elsewhere in the body and transferring it to the deficient area. The new piece of bone when healed and matured will then be capable of taking an implant. Most commonly, such grafts are taken from the chin region or from the back area of the lower jaw.

Does bone grafting affect the length of treatment?

Almost invariably treatment time is longer when bone grafting is required – however the process greatly improves the outcome of the implant treatment.

In certain situations the placement of the implant alongside the bone grafting with the use of a barrier membrane all at the same time will be recommended. This considerably reduces treatment time and can produce results that are difficult to achieve in any other way, however, many surgeons will still prefer to carry out bone grafting as a distinct stage, so that the implants are only placed when the bone grafting has been successful.